It’s time for PrEP to be made available for those who need it

Matthew Hodson

Thousands of gay and bisexual men have been let down by the decision of NHS England not to offer Pre-Exposure Prophylaxis (PrEP). Activists, HIV and LGBT organisations are aghast.

Over 3,300 gay and bisexual men were diagnosed with HIV in 2014; unless we add to our prevention options, we will see similar figures, or worse, in the years to come. Here was the opportunity to make a significant contribution towards ending HIV and the authorities have muffed it.

As the NHS statement admits, numerous studies, including the Proud study, have found that found that PrEP massively reduced the risk of infection. For preventing HIV, PrEP is more effective than condom use. We don’t need to waste more time with further trials, and the offer of £2m to fund a trial for just 500 gay men is merely insulting in the context of the thousands who are likely to become diagnosed in that time.

Let’s be clear, PrEP isn’t going to be right for everyone. I’m not advocating for all gay men to start taking pills daily. Condoms are a much cheaper strategy and with fewer side-effects (although PrEP is generally well-tolerated). We could go back and forth on the reasons why men don’t use condoms, and please don’t doubt that I’m a big advocate of condom-use, but let’s not allow men to become infected with HIV needlessly while we do so.

Most men diagnosed with HIV knew that condoms can prevent infection. Some of these men had been prescribed PEP (Post-Exposure Prophylaxis) to prevent infection, some of them more than once, and many of them had been diagnosed with a number of other STIs. PrEP wasn’t available for these men and as a result they will need treatment and care for the rest of their lives.

There is a group of gay men who clearly would benefit from PrEP and who are already demanding it. Not offering PrEP to these men will result in many of them becoming HIV-positive. This is not acceptable.

At GMFA we want to see fewer men become HIV-positive. We will do what we can to ensure that gay men are well informed about sexual risk and how such risks can be avoided or minimised. We will continue to lobby for more money to put into prevention work (we receive no Government funding for our website, FS or our sexual health campaigns) and for gay men’s health to be treated holistically, looking at all of the factors that contribute to our health inequalities.

PrEP is not a magic bullet. It won’t prevent other STIs, some men will struggle to take it often enough to be effective (although Proud found that men who needed it most, and were highly motivated, did take it) and it is expensive. However it is a very useful weapon in our anti-HIV armoury, able to prevent infections in the highest of high-risk groups. And unlike HIV treatment, which is for life, PrEP can be limited to those periods when men are at greatest risk of acquiring HIV, and therefore effectively much cheaper.

It is not time to chuck out condoms or forget that gay men’s health needs are many and varied. There is still a need to challenge HIV stigma so that men can have more honest and more frequent conversations about actual sexual risk and to ensure that all gay men are informed and empowered to take control of their sexual health.

We are starting to win the battle on HIV testing, with the proportion of gay and bisexual men who are unaware of their infection dropping. Early access to treatment will make these men less likely to pass the virus on to their sexual partners. We still need to do more to ensure that campaigns promoting condom use resonate with the target audience and that the trend away from condom use is reversed.

But we should not let tradition alone dictate how HIV is prevented. We now have all the tools that we need to effectively end new HIV infections, however, the puzzle is not complete unless we can add to our prevention armoury. PrEP’s effectiveness has been proven. This is no time for hesitation or procrastination. PrEP is needed now.

It seems almost every time I read an American paper, or read online news, another gay teenager in the US has committed suicide. I sit there and read the article talking about how they were a ‘promising student’ or a ‘loving son’, I see the photo of their young face and every time my heart breaks a little more. If only I could have spoken to them, held their hand and told them it’ll be all right and given them a hug. I feel so completely and utterly powerless to help.

If you just read about effective HIV treatment and life expectancy you’d be forgiven for thinking that HIV is no big deal these days. Sure your life might change but once you are diagnosed all you have to do is remind yourself to take your medication once a day, and eventually you will become undetectable and your life will go back to normal.

A recent study by University College London showed that HIV-negative gay men who have several symptoms of depression are more likely to have sex without a condom. Some American studies have also found an association between depression and risky sex.

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No assumptions should be made about the sexuality, HIV status or views of individuals or organisations featured on this website.The information provided on GMFA.org.uk is designed to support, not to replace, the relationship that exists between a patient/site visitor and his/her physician.